Healthcare Provider Details

I. General information

NPI: 1508393620
Provider Name (Legal Business Name): JUDY L YIP DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD STE 206
PLACENTIA CA
92870-3763
US

IV. Provider business mailing address

1041 E YORBA LINDA BLVD STE 206
PLACENTIA CA
92870-3763
US

V. Phone/Fax

Practice location:
  • Phone: 714-528-8252
  • Fax:
Mailing address:
  • Phone: 714-528-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS104025
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number104025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: